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KP Forms
KP Forms
_____________ , 20___
In compliance with Section 1 (a), Chapter 7, Title One, Book III, Local Government
Code of 2091 (Republic Act No. 7160), of the Katarungang Pambarangay Law, notice
is hereby given to constitute the Lupong Tagapamayapa of this Barangay. The
persons I am considering for appointment are the following:
1. __________________________________ 13. ____________________________________
2. __________________________________ 14. ____________________________________
3. __________________________________ 15. ____________________________________
4. __________________________________ 16. ____________________________________
5. __________________________________ 17. ____________________________________
6. __________________________________ 18. ____________________________________
7. __________________________________ 19. ____________________________________
8. __________________________________ 20. ____________________________________
9.
10. __________________________________ 21. ____________________________________
11. __________________________________ 22. ____________________________________
12. __________________________________ 23. ____________________________________
13. __________________________________ 24. ____________________________________
25. ____________________________________
They have been chosen on the basis of their suitability for the task of conciliation considering
their integrity, impartiality, independence of mind, sense of fairness and reputation for probity
in view of their age, social standing in the community, tact, patience, resourcefulness,
flexibility, open mindedness and other relevant factors. The law provides that only those
actually residing or working in the barangay who are not expressly disqualified by law are
qualified to be appointed as Lupon members. All persons are hereby enjoined to immediately
inform me and of their opposition to or endorsement of any or all the proposed members or
recommend to me other persons not included in the list but not later than the _____________
day of _________, 20 _____ (the last day for posting this notice).
___________________________
Punong Barangay
____________, 20
(Date)
APPOINTMENT
TO: __________________________
Pursuant to Chapter 7, Title One, Book III, Local Government Code of 2091
(Republic Act No. 7160), you are hereby appointed MEMBER of the Lupong
Tagapamayapa of this Barangay effective upon taking your oath of office and until a
new Lupon is constituted on the third year following your appointment.
______________________________
Punong Barangay
ATTESTED:
___________________________
Barangay Secretary
KP Forms No. 3
____________, 20
(Date)
____________________________
____________________________
____________________________
Sir/Madam:
Please be informed that you have been appointed by the Punong Barangay as a
MEMBER OF THE LUPONG TAGAPAMAYAPA, effective upon tking your oath
of office, and until a new Lupon is constituted on the third year following your
appointment. You may take your oath of office before the Punong Barangay on
____________________________.
___________________________
Barangay Secretary
KP Forms No. 4
____________, 20
(Date)
Punong Barangay
ATTESTED:
_______________________
Barangay/Lupon Secretary
_____________________________________________________________________
IMPORTANT: This is shall be posted in three (3) conspicuous places in the barangay for the duration of the terms
of office of those named above.
WARNING: Tearing or defacing this notice shall be subject to punishment according to law.
KP Form No. 5
OATH OF OFFICE
Pursuant to Chapter 7, Title One, Book 11, Local Government Code of 2091
(Republic Act No. 7160), I, ______________________, being duly qualified and
having been duly appointed member of the Lupong Tagapamayapa of this Barangay,
do hereby solemnly swear (or affirm) that I will faithfully and conscientiously
discharge to the best of my ability my duties and my functions as such member and as
member of the Pangkat ng Tagapagkasundo in I which may be chosen to serve; that I
will bear true and allegiance to the Republic of the Philippines; that I will support and
defend its Constitution and obey the laws, legal orders, and decrees promulgated by
its duly constituted authorities; and that I voluntarily impose upon myself this
obligation without any mental reservation or purpose of evasion.
SO HELP ME GOD. (In case of affirmation the last sentence will be omitted.)
___________________
(Member)
_________________________
Punong Barangay
KP Form No. 6
_____________, 20____
(Date)
WITHDRAWAL OF APPOINMENT
TO:_______________
After due hearing and with the concurrence of a majority of all Lupong
Tagapamayapa members of this Barangay, your appointment as member thereof is
hereby withdrawn effective upon receipt hereof, on the following ground/s:
____________________________________________________________________
____________________________
Punong Barangay/Lupon Chairman
CONFORME (Signatures):
1. ______________________ 7. ______________________
2. ______________________ 8. ______________________
3. ______________________ 9. ______________________
4. ______________________ 10. _____________________
6. ______________________ 11. _____________________
_____________________
(Signature)
____________________________________________________________________
NOTE: The members of the lupon conforming to the withdrawal must personally affix their signature or thumb marks on the
pertinent spaces above. The withdrawal must be conformed to by more than one-half of the total number of the members of the
lupon including the punong barangay and the member concerned.
KP Form No. 7
Republic of the Philippines
Province of ____________________
City/Municipality _______________
Barangay ______________________
____________________
- against -
____________________
____________________
____________________
Respondent/s
COMPLAINT
I/WE hereby complain against the above named respondents for violating
my/our rights and interests in the following manner:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_______________
Complianant/s
________________________
Punong Barangay/Lupon Chairman
KP Form No. 8
NOTICE OF HEARING
(MEDIATION PROCEEDINGS)
TO: ___________________
___________________
Complainant/s
_____________________________
Punong Barangay/Lupon Chairman
Complainant/s:
___________________
___________________
KP Form No. 9
SUMMONS
TO: _________________________ __________________________
_________________________ __________________________
Respondents
You are hereby summoned to appear before me in person, together with your witnesses, on the
_____ day of _____________, 20___ at _______________ at _____o’clock in the morning/afternoon,
then and there to answer to a complaint made before me, copy of which is attached hereto, for
mediation, conciliation of your dispute with complainant/s.
You are hereby warned that if you refuse or willfully fail to appear in obedience to this
summons, you may be barred from filling any counterclaim arising from said complaint.
FAIL NOT or else face punishment as for contempt of court.
This _____ day of _______________, 20____.
______________________________
Punong Barangay/Pangkat Chairman
_______________________________________________________
OFFICER’S RETURN
I served this summons upon respondent _____________________ on the ____ day of
__________________, 20___, and upon respondent on the day of ______________________, 20___,
by: (Write name/s of respondent/s before mode by which he/she was/were served.)
Respondent/s
___________________ 1. Handing to him/them said summons in person
___________________ 2. Handing to him/them said summons and he/they refused to receive it
___________________ 3. Leaving said summons at his/their dwelling with _________________,
(Name)
a person or suitable age and discretion residing therein
____________________ 4. Leaving said summons at his/their office/place of business with
___________, a competent person in charge thereof.
(Name)
________________________
Officer
Received by Respondent/s Representative/s
_____________________ ________________________
(Signature) (Date)
______________________ ________________________
(Signature) (Date)
KP Form No. 12
NOTICE OF HEARING
(CONCILIATION PROCEEDINGS)
Your are hereby required to appear before the pangkat on the ____ day of
__________________, 20___, at _____________ o’clock in the morning/afternoon for a
hearing of the above-entitled case.
___________________
Pangkat
Chairman
Complainant/s: Respondent/s:
_____________________
___________________
_____________________
___________________
KP Form No. 13
____________________
- against -
____________________
____________________
Respondent/s
SUBPOENA
TO:
_____________________________
Punong Barangay/Pangkat
Chairman
(Cross out whichever one is not
applicable)
KP Form No. 14
____________________
- against -
____________________
____________________
Respondent/s
Complainant/s: Respondent/s:
_____________________ _____________________
_____________________ _____________________
ATTESTATION:
I hereby certify that the foregoing Agreement for Arbitration was entered into
by parties freely and voluntarily, after I had explained to them the nature and
consequences of such agreement.
_____________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever is not applicable)
KP Form No. 15
Republic of the Philippines
Province of ____________________
City/Municipality _______________
Barangay ______________________
____________________
- against -
____________________
____________________
Respondent/s
ARBITRATION AWARD
After hearing the testimonies given and careful examination of the evidences
presented in this case, award is hereby made as follows:
_______________________________________________
_______________________________________________
_______________________________________________
___________________________
Punong Barangay/PangakatChairman*
__________________
Member
__________________
Member
ATTESTED:
____________________________
Punong Barangay/Lupon Secretary**
_______________________________________________________________________
KP Form No. 16
____________________
- against -
____________________
____________________
Respondent/s
AMICABLE SETTLEMENT
and bind ourselves to comply honestly and faithfully with the above terms of
settlement.
Complainant/s: Respondent/s:
______________________
______________________
______________________
______________________
ATTESTATION:
I hereby certify that the foregoing amicable settlement was entered into by the parties freely
and voluntarily, after I had explained to them the nature and consequence of such settlement.
_____________________________
Punong Barangay/Pangkat Chairman
KP Form No. 17
____________________
- against -
____________________
____________________
Respondent/s
REPUDIATION
I/WE hereby repudiate the settlement/agreement for arbitration on the ground that my/our
consent was vitiated by:
Complainant/s Respondent/s
___________________________ __________________________
___________________________ __________________________
_____________________
Punong Barangay
___________________________________________________________________________________
___* Failure to repudiate the settlement or the arbitration agreement within the time limits respectively
set [ten (10) days from date of settlement and (5) days from the date of arbitration agreement]
shall be deemed a waiver of the right to challenge on said grounds.
KP Form No. 18
____________________
- against -
____________________
____________________
Respondent/s
NOTICE OF HEARING
(RE: FAILURE TO APPEAR)
TO: __________________
__________________
Complainant/s
You are hereby required to appear before me/the Pangkat on the ____ day of
____________, 20 ___, at ____________ o’clock in the morning/afternoon to explain
why you failed to appear for mediation/conciliation scheduled on ______________,
20 ___ and why your complaint should not be dismissed, a certificate to bar the filling
of your action in court/government office should not be issued, and contempt
proceedings should not be initiated in court for willful failure or refusal to appear
before the Punong Barangay/Pangkat ng Tagapagkasundo.
Complainant/s: Respondent/s:
____________________ _________________
KP Form No. 19
Republic of the Philippines
Province of ____________________
City/Municipality _______________
Barangay ______________________
____________________
- against -
____________________
____________________
Respondent/s
NOTICE OF HEARING
(RE: FAILURE TO APPEAR)
TO: ___________________
___________________
Respondent/s
You are hereby required to appear before me/the Pangkat on the ____ day of
________________, 20 ___, at ___________ o’clock in the morning/afternoon to explain
why you failed to appear for mediation/conciliation scheduled on ________________, 20
____ and why your counterclaim (if any) arising from the complaint should not be dismissed,
a certificate to bar the filling of said counterclaim in court/government office should not be
issued, and contempt proceedings should not be initiated in court for willful failure or refusal
to appear before the Punong Barangay/Pangkat ng Tagapagkasundo.
______________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever is not applicable)
Complainant/s: Respondent/s:
___________________ ____________________
___________________ ____________________
KP Form No. 20
____________________
- against -
____________________
____________________
Respondent/s
1. There has been a personal confrontation between the parties before the Punong
Barangay/Pangkat ng Tagapagkasundo.
3. The settlement has been repudiated in a statement sworn to before the Punong
Barangay by _____________________ on ground of
______________________.
4. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.
__________________
Lupon Secretary
ATTESTED:
____________________
Lupon Chairman
____________________
- against -
____________________
____________________
Respondent/s
1. There has been a personal confrontation between the parties before the Punong
Barangay but mediation failed.
3. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.
__________________
Pangkat Secretary
ATTESTED BY:
____________________
Pangkat Chairman
____________________
- against -
____________________
____________________
Respondent/s
1. There has been a persona confrontation between the parties before the Punong
Barangay but mediation failed.
2. The Punong Barangay set the meeting of the parties for the constitution of the
Pangkat.
4. Therefore, the corresponding compliant for the dispute may now be filed in
court/government office.
__________________
Pangkat Secretary
ATTESTED:
___________________
Pangkat Chairman
KP Form No. 21
____________________
- against -
____________________
____________________
Respondent/s
This is to certify that the above-captioned case was dismissed pursuant to the
Order dated _________________, for complainant/s __________________ and
(Name)
_____________________willful failure or refusal to appear for hearing before the
(Name)
Punong Barangay/Pangkat ng Tagapagkasundo and therefore complainant/s is/are
barred form filing an action in court/government office.
____________________________
Lupon Secretary/Pangkat Secretary
ATTESTED:
_____________________________
Lupon Chairman/Pangkat Chairman
____________________________________________________________________
IMPORTANT: If the Lupon Secretary makes the certification, the Lupon Chairman attests. If the Pangkat
Secretary makes the certification, the Pangkat Chairman attests.
KP Form No. 22
____________________
- against -
____________________
____________________
Respondent/s
This is to certify that after prior notice and hearing, the respondent/s
_____________________ and ______________________ have been found
(Name) (Name)
to have willfully failed or refused t appear without justifiable reason before the
Punong Barangay/Pangkat ng Tagapagkasundo and therefore respondent/s is/are
barred from filing his/their counterclaim (if any) from the complaint in
court/government office.
____________________________
Lupon Secretary/Pangkat Secretary
ATTESTED:
_____________________________
Lupon Chairman/Pangkat Chairman
_____________________________________________________________________
IMPORTANT: If the Lupon Secretary makes the certification, the Lupon Chairman attests. If the
Pangkat Secretary makes the certification, the Pangkat Chairman attests.
KP Form No. 23
____________________
- against -
____________________
____________________
Respondent/s
2. The period of ten (10) days from the above-stated date has expired without
any of the parties filings a sworn statement of repudiation of the settlement
before the Lupon Chairman a petition for nullification of the arbitration award
in court.
____________
(Date)
________________________
Complainant/s/Respondent/s
KP Form No. 24
____________________
- against -
____________________
____________________
Respondent/s
NOTICE OF HEARING
(RE: MOTION FOR EXECUTION)
____________________
(Date)
_____________________________
Punong Barangay/Lupon Chairman
_________________ _________________
_________________ _________________
(Signature) (Signature)
Complainant/s Respondent/s
KP Form No. 25
Republic of the Philippines
Province of ____________________
City/Municipality _______________
Barangay ______________________
____________________
- against -
____________________
____________________
Respondent/s
NOTICE OF EXECUTION
WHEREAS, the terms and conditions of the settlement, the dispositive portion of the
award, read: __________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
The said settlement/award is now final and executory;
__________________
Punong Barangay
Copy furnished:
__________________ ______________
Complainant/s Respondents/s
Specific offenses carry a penalty of not more than one year imprisonment:
The Revised Penal Code enumerates specific cases in which penalties are not
more than one year of imprisonment, to wit: